Ecthyma gangrenosum as a serious complication of Pseudomonas aeruginosa infection in departments of pediatric oncology

Abstract

In most cases ecthyma gangrenosum is a consequence of Pseudomonas aeruginosa bloodstream infection in immunodeficient patients. This bacterium is characterized by multi-drug resistance and has a number of mechanisms that allow it to survive even in extreme conditions. The disease is characterized by an aggressive course involving the skin and mucous membranes, leading to ulceration with signs of necrosis within 12 to 24 h. Treatment includes targeted antibiotic therapy and surgical cleansing of the wound. If the perianal area is occupied, a colostomy may be performed. Prevention of bacterial infections involves taking special precautions when handling a patient with immunodeficiency.

Ecthyma gangrenosum in pediatric patients: 10‐year experience at the National Institute of Pediatrics

“…Once EG is clinically suspected and cultures have been taken, empirical antibiotics must be started. A broad‐spectrum β‐lactam (imipenem or cefepime), gentamicin, or fluoroquinolones to cover pseudomonal infection is mandatory 10 . When the etiology is defined, the treatment must be individualized according to the microorganism and antibiotic sensitivity since there is no standardized treatment due to the diversity of etiological agents.…”

“…A broad-spectrum b-lactam (imipenem or cefepime), gentamicin, or fluoroquinolones to cover pseudomonal infection is mandatory. 10 When the etiology is defined, the treatment must be individualized according to the microorganism and antibiotic sensitivity since there is no standardized treatment due to the diversity of etiological agents. In some cases, like in almost one-third of our patients, surgical debridement should also be considered.…”

“…1,[4][5][6][7][8][9] EG usually starts as asymptomatic erythematous or violaceous macules, papules, or plaques with surrounding erythema which progress in 12-24 hours to hemorrhagic bullae and necrotic ulcerative eschars (Figures 1 and 2). 10 EG can present as single or multiple lesions affecting most often the perineum, lumbar and gluteal regions (57%), extremities (30%), face (6%), neck and torso (6%), but it can affect any body segment. 1,10 Common nonspecific systemic findings such as fever, pain, and flu-like symptoms can be part of the initial presentation; if sepsis is present, weakness, anorexia, diarrhea, and tachycardia may also be seen.…”

“…10 EG can present as single or multiple lesions affecting most often the perineum, lumbar and gluteal regions (57%), extremities (30%), face (6%), neck and torso (6%), but it can affect any body segment. 1,10 Common nonspecific systemic findings such as fever, pain, and flu-like symptoms can be part of the initial presentation; if sepsis is present, weakness, anorexia, diarrhea, and tachycardia may also be seen. 10,11 Diagnosis must be suspected by clinical recognition, and empirical antimicrobial treatment covering Pseudomonas sp.…”

“…1,10 Common nonspecific systemic findings such as fever, pain, and flu-like symptoms can be part of the initial presentation; if sepsis is present, weakness, anorexia, diarrhea, and tachycardia may also be seen. 10,11 Diagnosis must be suspected by clinical recognition, and empirical antimicrobial treatment covering Pseudomonas sp. must be started immediately due to the severity of the condition.…”